Tuesday, March 22, 2005

The Milwaukee-based Northwestern Mutual Life Insurance Company has announced that starting next year, it will impose a $25 per month health insurance coverage surcharge on employees who smoke - whether they smoke at work or at home, according to an article in the Milwaukee Journal Sentinel. Apparently, the surcharge will apply not only if the employee smokes, but also if a covered family member smokes. The article cites a Northwestern Mutual spokeswoman as saying: "We are not seeing this as a punishment in any way. We're just looking at different ways to incentivize people."

This announcement comes in the wake of Okemos, Michigan-based Weyco, Inc.'s decision to fire four employees who continued to smoke after a new policy requiring employees to quit smoking went into effect this past January. The policy makes it a firing offense for employees to smoke, whether they smoke at work or at home. The policy was announced one year in advance and smokers were offered cessation classes. Most of the smokers apparently quit, but four who did not were fired. A Lansing State Journal article quoted Weyco owner Howard Weyers as explaining that: "You can do whatever you want, but if you're going to work here, you can't be a smoker, like you can't be a drug user."

A third approach, in addition to firing smokers or imposing health insurance surcharges, that seems to be increasingly used by employers, reportedly in an effort to control health-realted expenses, is the refusal to hire smokers in the first place. For example, Union Pacific Corporation apparently instituted a pilot program in which it rejects the application of any prospective employee who indicates that he or she smokes.

The Rest of the Story

The actions of Weyco, Inc., Northwestern Mutual Life, Union Pacific Corporation, and other companies raises a question that is broader and perhaps more important than the question of employment policies regarding smokers: Is it appropriate for an employer to interfere in the legal, off-duty, private activities and lifestyle decisions of workers? There is little question that an employer has a legitimate interest in controlling behavior of its employees on-the-job. For many reasons, smoking while at work may be viewed as interfering with the performance of one's duties, may impose excess maintenance and cleaning costs, and may violate building smoking policies. However, there does not seem to be a legitimate employer interest in controlling employee's lawful activities off the job, or at least certainly not an interest so substantial that it would justify the degree of intrusion into an employee's private life that these policies represent.

These policies regarding smoking raise the question of what other life decisions employers will try to control next. Will they start imposing surcharges on, refusing to hire, or firing workers who are overweight, eat a lot of fast food, or fail to get enough physical activity? The argument that these smoking policies are simply an effort to "incentivize" workers does not hold water. So would a policy to require employees to lose weight, eat nutritious food, or engage in a certain amount of physical activity. And the comparison between smoking and drug use that the Weyco owner made is not relevant, since smoking is a legal activity; no one would argue that an employer should not be able to make employment decisions based on criminal behavior on the part of their workers.

As courts have thus far upheld employers' rights to use smoking as a factor in hiring decisions, some states have enacted laws that specifically disallow companies to refuse to hire smokers. But perhaps these laws are tailored too narrowly. Should the law not reflect the value that society places on freedom to engage in lawful activities and have autonomy of personal decision-making (as long as one does not engage in illegal behavior) outside of the workplace? Should such laws not simply state that lawful activities performed outside the workplace are not in the realm of factors that can be considered in employment decisions?

Regardless of the legal issues raised by these smoking employment policies, it is important to recognize that from a public health and tobacco control standpoint, there is no justification for promoting these policies, which represent an infringement on the autonomy of individuals to make lifestyle choices outside of the workplace, even if they may be unhealthy choices.

UPDATE (March 25, 10:00 am): For a published debate over this issue, see the April 2005 issue of Tobacco Control: Gray NJ. The case for smoker-free workplaces. Tobacco Control 2005; 14: 143-144 and Chapman S. The smoker-free workplace: the case against. Tobacco Control 2005; 14: 144.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.